1427160688 NPI number — WOBURN FAMILY CHIROPRACTIC INC

Table of content: (NPI 1427160688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427160688 NPI number — WOBURN FAMILY CHIROPRACTIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOBURN FAMILY CHIROPRACTIC INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427160688
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 CUMMINGS PARK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOBURN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-938-9400
Provider Business Mailing Address Fax Number:
871-938-9323

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 CUMMINGS PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOBURN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-938-9400
Provider Business Practice Location Address Fax Number:
871-938-9323
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PENDOLINO
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
TODD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
781-938-9400

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  157 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AA7544 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1697021 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2611483 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 460083 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: Y39772 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com